Image-Guided Minimally Invasive Treatment of Pulmonary Arterial Hypertension Due to Embolic Disease
| Autor: | A. Mainar, Rosario Ortas, Alicia Laborda, J. Gómez-Arrue, Miguel Ángel de Gregorio, Teresa Higuera, Joaquín Medrano |
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| Rok vydání: | 2008 |
| Předmět: |
Diagnostic Imaging
Male medicine.medical_specialty Hypertension Pulmonary medicine.medical_treatment Doppler echocardiography Angioplasty medicine.artery medicine Pulmonary angiography Humans Prospective Studies Pulmonary wedge pressure Aged medicine.diagnostic_test Pulmonary thromboendarterectomy business.industry Stent General Medicine Middle Aged medicine.disease Pulmonary hypertension Surgery Pulmonary artery Female Stents Radiology Pulmonary Embolism business |
| Zdroj: | Archivos de Bronconeumología ((English Edition)). 44:312-317 |
| ISSN: | 1579-2129 |
| DOI: | 10.1016/s1579-2129(08)60051-8 |
| Popis: | surgical pulmonary thromboendarterectomy is the treatment of choice for pulmonary hypertension due to chronic thrombotic and/or embolic disease, minimally invasive endovascular techniques such as angioplasty or placement of a metallic stent can provide acceptable results when surgery is not indicated or has been refused by the patient. PATIENTS AND METHODS: Eight patients (5 men, 3 women; mean age, 62.6 years) were treated. The patients were in New York Heart Association (NYHA) class III or IV and had a mean pulmonary artery pressure of 40 mm Hg or more, a capillary wedge pressure of 15 mm Hg or less, and a Miller index greater than 0.5. In all cases, diagnosis was based on Doppler echocardiography, pulmonary angiography, hemodynamic evaluation, and ventilationperfusion scintigraphy. All patients received fibrinolytic therapy and underwent angioplasty. A metallic stent was implanted in 3 patients. Follow-up echocardiographic assessment and ventilation-perfusion scans were scheduled at 1, 3, 6, and 12 months. RESULTS: The procedures were technically successful in all cases. The mean follow-up period was 18.7 months. Minor complications were extrasystoles (3 cases), slight bruising at the site of puncture (1 case), and rectal bleeding that resolved without treatment (1 case). One patient died from an unknown cause 24 hours after the procedure. In all other cases, improvements were noted in NYHA functional class, in hemodynamics demonstrated by echocardiography, and in vascular structure as shown by arteriography and scintigraphy. CONCLUSIONS: Minimally invasive endovascular interventions can help improve pulmonary arterial hypertension due to chronic thrombotic and/or embolic disease in patients for whom medical or surgical treatment is not possible. |
| Databáze: | OpenAIRE |
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